Month: April 2019

Students with hearing loss have less access to communication. This will result in a slower pace of learning and fewer gains in academic knowledge unless appropriate services and supports are provided. At the end of the school year it is important to ask whether your students have learned the amount expected of their grade level. Has the level of support been sufficient? We need to use data in our planning for next year’s success!

Decreased speech perception translates into decreased comprehension, especially of novel words and new information. Most students who are deaf and visual communicators primarily receive communication from their classroom interpreter with little meaningful conversation or information exchange directly with peers. Regardless of the communication modality, progress through the curriculum at the same rate as class peers assumes that the student is fully participating and has received the same information as those peers. It’s all about access!

Question from the field: We are a small school district and only offer an ASL interpreter for students with hearing loss, but more and more students are now using spoken language. Are there interpreting services or supports that we need to offer these students who do not use ASL?

Depending on a student’s mode of communication, there are various options available for providing access in the educational setting. For the students who are receiving access to spoken language earlier and have better hearing technology, ASL is often not their primary language.

Question from the field: We are a small school district and only offer an ASL interpreter for students with hearing loss, but more and more students are now using spoken language. Are there interpreting services or supports that we need to offer these students who do not use ASL?

Depending on a student’s mode of communication, there are various options available for providing access in the educational setting. For the students who are receiving access to spoken language earlier and have better hearing technology, ASL is often not their primary language.

There are language options and communication strategies available for families whose children have hearing loss1. Families may decide to use any of or a combination of the following:

Spoken Language – developing the use of spoken language in the primary language of the family and/or education system using the mouth and vocal cords

American Sign Language (ASL) – a complete language system that uses signs with the hands combined with facial expression and body posture. ASL includes visual attention, eye contact and fingerspelling.

Manually Coded English (MCE) – the use of signs that represent Englishwords. Many of the signs are borrowed from ASL, but use the word order, grammar, and sentence structure of English.

Cued Speech – a system of hand signals to help the listener with hearing loss identify the differences in speech sounds that are difficult to discriminate through listening.

Conceptually Accurate Signed English (CASE)/Pidgin Sign English (PSE) – a mix of ASL signs used in English word order.

Simultaneous Communication – used in order to speak out loud while signing using CASE or PSE.

Bilingual-Bicultural (Bi-Bi) – typically the use of ASL as the student’s first language and primary mode of communication while learning to read and write in English.

Supports – There are various strategies that support effective communication for students with hearing loss who use spoken language. Resources can be found on the Accommodations for Students with Hearing Loss webpage. The need for captioning, notetaking, captioned media, and other supports like preteaching/review of vocabulary also must be considered to ‘equal the playing field’ for students who are constantly missing information during classroom communication due to hearing loss.

IDEA – The IDEA requires that public school districts provide for a free, appropriate public education (FAPE) in the least restrictive environment (LRE). In the IEP meeting, the team must consider and document the students mode of communication in the IEP. This should not be assumed to be ASL if the student uses spoken language or an alternative mode of visual communication to access their education. Some students will need sign language interpreters who use ASL, Cued Speech, or SEE while other students who do not use visual modes of communication may require transcription services. (28 C.F.R. 35.104)

ADA – Under the Americans with Disabilities Act (ADA) and Section 504 programs which receive federal financial assistance need to “provide accommodations, such as qualified interpreters, real-time Captioning (also called CART), assistive listening devices, or other auxiliary aids, to people with disabilities when necessary to ensure effective communication.” (Section 504, 29 U.S.C. 794) Therefore, depending on the child’s language and mode of communication the district will need to ensure that the student is able to access not only instruction in all of their classes, but also all activities associated with the school experience to which their typically developing, typically hearing peers have access. The school district must provide whatever interpreting service is included in the IEP or 504 Plan for all school-related activities including assemblies, school-related field trips, extracurricular programs, teacher conferences, social and cultural activities, and summer school or hobby classes.

In the IEP document the need for access services would be included in the Special Factors section under considerations if the student is Deaf/Hard of Hearing. Many IEP teams will also include the interpreting service in the Low Incidence section, the Accommodations section, the service grid, and also in the discussion notes of the IEP and in the offer of FAPE.

Because special education and IEPs are based on a failure model, some teams struggle to find the justification for including interpreting services. This is when the family and team need to consider the regulations of the ADA in addition to the IDEA and focus on the need to provide equal access in the educational setting. The Office of Civil Rights has ruled that public school systems must give equal access to extracurricular programs. “School systems should routinely publicize the method that deaf and hard of hearing persons can use the request necessary services such as qualified interpreters, real-time captioning (also called CART), or assistive listening devices.”2

In my own experience I have seen all of the following successfully provided for students:

For an 8th grade student, the school district allowed the student to take his Roger DM system on the Spring Break trip to Washington DC.

I had a 16-year-old student who regularly participated in her own IEP meetings, so the school provided both her FM system and CART services during the IEP meetings.

I have had multiple preschool students whose schools were inserviced so that they understood the role and benefit of the ASL interpreter and/or FM systems. They consistently provided these supports during field trips and walks through the neighborhood outside of the classroom.

Finally, I had an 18-year-old student with a cochlear implant who uses spoken language. Her school provided 2 note-takers to travel with her on a school trip from California to Hawaii so that she could access the lectures held on hikes and on top of volcanoes.

Students with hearing loss have less access to communication. This will result in a slower pace of learning and fewer gains in academic knowledge unless appropriate services and supports are provided. At the end of the school year it is important to ask whether your students have learned the amount expected of their grade level. Has the level of support been sufficient? We need to use data in our planning for next year’s success!

Decreased speech perception translates into decreased comprehension, especially of novel words and new information. Most students who are deaf and visual communicators primarily receive communication from their classroom interpreter with little meaningful conversation or information exchange directly with peers. Regardless of the communication modality, progress through the curriculum at the same rate as class peers assumes that the student is fully participating and has received the same information as those peers. It’s all about access!

The law requires the IEP be reviewed at least once a year to determine if the child is achieving the annual goals (Section 1414(d)(4)(A)). The IEP team must revise the IEP to address any lack of expected progress and anticipated needs.

We need to not only strive to close language and learning gaps, we need to simultaneously support our students in keeping up with the day-to-day learning in the classroom. We MUST monitor progress to know if full access is truly occurring and to ensure that our students are keeping pace with classroom expectations. Without appropriate support, the trajectory of educational performance shown above is all too likely.

Students who are deaf or hard of hearing with no other learning issues – with full access to school communication – CAN progress at the expected rate IF they are receiving the appropriate intensity of focused support.

Compare Progress from Year-to-Year

Review your student files semi-annually for young children and annually for later elementary school-age students. If available, look at norm-referenced test results, like the high-stakes tests or language evaluations. Have the student’s percentile scores or standard scores stayed consistent? With your focused intervention and appropriate supports, have the student’s percentile scores improved? Or, like the previous figure depicts, has the student experienced inappropriate access and insufficient supports causing a decrease in performance over time?

For example, consider a student who scored in overall reading in

grade 2 at the 48thpercentile

grade 3 at the 38thpercentile

grade 5 at the 30th percentile

The student still continues to fall within 1 standard deviation from the mean, or within the ‘average’ range. However, a drop of 18 percentile points over 3 years raises the question about adequate yearly progress and if the access accommodations and intensity of services have truly ‘leveled the playing field’ for the student with hearing loss. The school team may not be concerned because the student still scores ‘average’ but to a professional with a background in the impact of hearing loss on learning, this trend should demand that more focused and appropriate supports/access accommodations be provided.

Needed Supports for Keeping Pace in the Classroom

Background, or world knowledge is necessary to build surface level understanding of a specific topic. Prior knowledge is an excellent predictor of performance. Our students tend to have ‘Swiss cheese language’ with unpredictable knowledge gaps in vocabulary and concepts. They also are often limited in the number of attributes they use to describe objects or concepts, further contributing to their gaps and limited world knowledge. Imagine learning about the conquistadors if you lacked knowledge of geography, discoveries of early explorers, and that there are different countries and they may desire different things. Previewing and reviewing new vocabulary is critical for the student to ‘keep up.’

Filling the gaps. We can expect that surface learning will take longer for students with hearing loss than their typically hearing peers. Students who have a less complete understanding of surface level information are not going to benefit to the same degree, or at the same rate, during interactive activities meant to move them to deeper understanding. “Closing the language gaps” is not just something that is a nice extra touch to provide to our students if there is a teacher of the deaf available; it is necessary for deeper learning. Add to this the fact that reduced listening ability often delays literacy skill development and slows reading fluency. Just teaching vocabulary, without sufficient phonological awareness, will not develop the reading fluency the students need for comprehension at the pace of peers. Filling in the gaps in prior knowledge is necessary if a child is to be able to develop the surface learning that is prerequisite to developing deeper understanding. Without this surface learning, a deeper understanding is not possible.

Conversational inequalities. Research4 has indicated that during one-on-one conversations in a quiet setting, students who are hard of hearing have conversational skills equivalent to their hearing peers. In a typical mainstream classroom, students with hearing loss make fewer overall communication attempts than their hearing peers. They also often seem unaware when their peers try to initiate conversation and do not attempt to maintain the conversation. When they attempt to maintain the conversation, they generally use one-to two-word phrases and do not add new information. The research found that in a 1:1 conversation, 75% of the conversation maintenance attempts by children with hearing loss were appropriate compared to 100% for hearing peers. They frequently tried to maintain the conversation by bringing up a topic that was unrelated to the conversation. In other words, they were not aware enough of the content of the conversation to contribute information, so they brought up a new topic.

Educational practices that seek to move students to deeper understanding typically involve interaction with peers. This is often very challenging for students with hearing loss when acoustic access inequality in the classroom results in conversational misunderstandings for students with hearing loss. This provides a powerful argument for the use of hearing assistance technology (HAT) that will improve perception of peer voices in 1:1 or group settings.

Challenges repairing breakdowns. Another aspect of conversation relates to what a person does when they do not fully understand. One study5 found that persons with hearing loss were able to cue into changes in topic but had much more difficulty when a shift in topic was made during the conversation. The research findings can be summarized as, “the more predictable the conversation, the fewer the likely breakdowns.” The teacher needs to be aware of this issue when pairing the student with different partners or groups. Moving to a quieter area for discussion will not ensure full participation by the student with hearing loss but it will make participation easier and more likely. Including him or her in a group that is more likely to stick to the topic will heighten the value of the exercise for the learner with hearing loss.

Keeping up in the classroom is a challenge for children with hearing loss due to access issues that interfere with understanding conversational communication and the gaps in knowledge resulting from decreased auditory access since infancy (or sign communication with limited language models since infancy). Filling the gaps of vocabulary and phonological awareness is necessary for students to keep up with class expectations for developing surface learning. Access to classroom discussion and for all group activities is a prerequisite for deep learning to occur. Providing the appropriate access technology is a necessity to facilitate deeper learning to occur within the classroom. Selecting appropriate group partners and honing communication repair skills is also critical to students with hearing loss achieving at the same rate and to the same level as peers.

Considerations for Monitoring Progress

ASL Content Standards – K – 12. Whichever communication modality is used by a student, he or she must have the skills to adequately communicate both receptively and expressively. Most families at this point prefer that their child learn to listen and speak. This preference does not always result in a child who has school entry skills. Whether the family has chosen to use sign from birth, or it is the modality deemed to be most effective for learning by a school team due to child’s lack of progress learning to listen and speak – a student must progress through learning ASL in a developmental sequence to prepare them to make academic gains at least at the rate of their class peers. Developed by Gallaudet, the ASL Content Standards for K-12 grade students were developed to ensure that children learn ASL in much the same way that hearing children in the US acquire and learn English. The Standards are a huge step forward in determining the student instruction needed and monitoring progress of ASL knowledge and use.

CURRICULUM BASED MEASURES: There is a need for functional assessments to monitor students’ academic performance. Curriculumbased measures provide a specific approach to measuring student learning that includes repeated measurement (weekly, monthly) across extended periods of time using general outcome indicators that are sensitive in the rate of change demonstrated in the performance of a task of the same difficulty. While curriculum-based measures (CBM) have been commonly used in public education, it is appropriate to consider CBM use for students who are deaf/hard of hearing specifically. Developed as part of a grant from the U.S. Office of Special Education Programs, the University of Minnesota has developed extensive progress CBM materials designed specifically for teachers of the deaf/hard of hearing to monitor students who have hearing loss and/or language differences. Go to the Education Resources for Teachers of Deaf/Hard of Hearing Students resource page for extensive training resources for teachers and specific means to monitor student progress. This truly is an amazing resource and would be great for professional learning collaboratives or self-study. The measures take only a few minutes each week!

MAZE ASSESSMENT: Monitoring performance via the MAZE assessment is a common form of curriculum-based measurement. Maze presents sentences or short stories with every 7th word missing. The student must select which of 3 words best fits the missing word in the sentence. Clearly, as can be seen in the bar graph, even our students with hearing loss who do not have IEP services and supports are not performing like their age peers. Learn more about creating MAZE reading passages here.

Monitoring Progress of Expanded Core Skills

Expanded core curriculum refers to those skills that students with hearing loss need to learn to be able to access the general education curriculum and fully participate. Even if a student is provided access to effective communication as required by Title II of the ADA, he or she still needs to learn the skills to independently, and confidently, navigate as a person with hearing loss in a mainstream setting. These areas will not be taught specifically and yet they must be learned if full participation in the classroom is expected.

Per the Iowa Expanded Core Curriculum guidance, hearing loss adds a dimension to learning that requires explicit teaching, such as information gained through incidental learning. It has been estimated that for persons without hearing loss, 80% of information learned is acquired incidentally. No effort is required. Any type of hearing loss interrupts this automatic path to gain information. This incidental information must be delivered directly to students who are deaf or hard of hearing. Two hierarchies for self-advocacy are the Guide to Self-Advocacy Skill Development and the Student Expectations for Advocacy and Monitoring (SEAM).

Most teachers without specialized training related to hearing loss do not have the expertise to address the unique needs of students who are deaf or hard of hearing. Therefore, IFSP & IEP team collaboration with educational audiologists and teachers of students who are deaf or hard of hearing is necessary in addressing academic and social instruction and the assessment of these areas. In order to close this information gap, the Expanded Core Curriculum for Students who are Deaf or Hard of Hearing (ECC-DHH) was developed. Texas has developed a Livebinder with extensive information about ECC and resources to support implementation.

Everyone wants students to have a good experience in school. Often part of this desire by families is for their child to not feel singled out as ‘different.’ While it is true that our students are just ‘normal kids who happen to be hard of hearing or deaf’, it is also true that having a hearing loss means that they will be different in some ways from their peers. There are actions that can be taken to reduce the social and self-esteem consequences of being a ‘one and only’.

Question from the field: I have a student whose IEP calls for an FM system. However, the system is not in place, and we are more than half way through the school year. What can I do as the teacher of the deaf to help get this student their system?

Why FM/DM Systems?

Many districts are now referring to FM/DM equipment as HATS, or Hearing Assistive Technology Systems. The use of HATS in the educational setting not only provides better access to the linguistic information, but as a result can help with development of speech and language skills, increase incidental learning, and can help with social skills in the classroom.

Question from the field: I have a student whose IEP calls for an FM system. However, the system is not in place, and we are more than half way through the school year. What can I do as the teacher of the deaf to help get this student their system?

Why FM/DM Systems?

Many districts are now referring to FM/DM equipment as HATS, or Hearing Assistive Technology Systems. The use of HATS in the educational setting not only provides better access to the linguistic information, but as a result can help with development of speech and language skills, increase incidental learning, and can help with social skills in the classroom.

A powerful teaching tool that demonstrates the benefits of HATS in the educational setting as well as the difficulty without it can be viewed on YouTube (Hearing Loss in the Classroom, St. John’s Medical Center1). This can be shared with families and educators alike to improve awareness of what a difference it can make to improve the signal to noise ratio.

HATS includes any of the following components2:

Teacher transmitter or teacher microphone: This is worn by the teacher and is synced with the students’ personal receivers. It can easily be muted and us muted as needed throughout the day.

Personal receivers (sometimes called boots): These are attached to the student’s hearing aids or cochlear implant processors.

Classroom sound-field systems: This allows the teacher and students to use a microphone(s) and have their voices amplified above the ambient noise for all students including the student with hearing loss to have better access.

Pass-around microphone: This is used by peers to provide access for the student during class discussions and peer-to-peer communication. If there is a sound-field system, then the student with hearing loss would also use the pass-around microphone. While a sound-field system typically does not provide a sufficient signal-to-noise enhancement for students with hearing loss2, with planning, personal HAT devices can often work in conjunction with sound-field classroom amplification systems. When there is a sound-field system and the student with hearing loss uses the microphone, just like class peers, the student is not singled out, thus supporting them socially, and enables them to use their auditory feedback loop in order to monitor and correct their own speech production.

Timing is Essential for FAPE

All placement, services, and goals offered in the IEP are effective upon signature by the parent or legal guardian and should be implemented immediately. A court case4 ruled against a school district who delayed the repair of a student’s FM system, even through the student maintained good grades saying, “his maintenance of good grades was due to his own diligence. The school was found to have denied the student FAPE and violated section 504.

If the IEP team recommended and offered the FM/DM technology in the IEP, then it should be in place prior to the first day of school. Of course, if equipment needs to be ordered and the student is starting school immediately, then every effort should be taken to ensure the student has appropriate auditory access to everything being said in the classroom as soon as possible. Different school districts differ in the way in which they acquire technology. In speaking with and working directly with the companies that supply these systems, there is no reason for there to be a month-long delay (let alone half of a school year). Some companies are also willing to send a system for the child to use as a “loaner” device while the district is going through their procedural process to obtain the equipment offered in the IEP.

The Barrier of Lack of Audiology Expertise

Students who are eligible for specialized instruction as Deaf/Hard of Hearing comprise one of the populations considered under low incidence disabilities. The discussion of low incidence equipment is one that is unique to students whose eligibilities require “personnel with highly specialized skills and knowledge … to receive early intervention services or a free appropriate public education”5 The Educational Audiologist is the service provider responsible for ordering assistive hearing technology6. Sometimes, school administration will put pressure on the teacher of the deaf/hard of hearing or the speech language pathologist to obtain HAT systems for students, which is inappropriate as recommending HAT equipment is outside the role and responsibility of both of these professionals.7 If you are in a circumstance where your district does not have an Educational Audiologist on the team, or if there is a lack of audiology service time to ensure prompt provision of the equipment, it is important for you to approach the administrator to find a solution. A clinical audiologist, especially one specializing in pediatrics, has the expertise to recommend appropriate HAT equipment for use in the school setting.

Be Empowered to Advocate

Facilitating the ordering of the required technology is necessary for your student to receive appropriate access to instruction and classroom communication. As the teacher of students who are deaf/hard of hearing you should feel empowered to let your district know that for your student to spend any time without the FM/DM system is like asking a student in a wheel chair to wait for the district to build a ramp and widen the doorway before that student can enter class and begin to participate with their peers.

“We don’t want to call attention to his hearing loss. We want him to be “normal.”

Students with hearing devices are typically educated in their neighborhood schools and are the only ones in their grade or the school to have a hearing loss. Everyone wants students to have a good experience in school. Often part of this desire by families is for their child to not feel singled out as ‘different.’ While it is true that our students are just ‘normal kids who happen to be hard of hearing or deaf’, it is also true that having a hearing loss means that they will be different in some ways from their peers.

What does this approach mean for the student?

It does not take calling attention to the hearing loss for the class peers to recognize that there is a hearing loss – or something – different about the child. In any group where the same people are together day after day the fact that one of the group wears hearing devices will soon become known. Either by seeing the hearing devices, or by experiencing the child not responding typically in certain situations (listening in noise, distance, fast/quiet conversations, etc.) the other students will identify the child as being different.

Psychosocial development informs us that between age 4-6 years that children are learning what is acceptable and not acceptable to the peer group. Research has indicated that early rejection by peers is associated with persistent academic and social difficulties. By including the child with hearing loss in the mainstream environment without letting the peers know anything about the child’s hearing devices or communication needs the child faces exclusion from the peer group and often has no knowledge or strategies to cope with the situation.

Example of cascading effects of not informing peers of the hearing loss/hearing devices:

Jimmy is excited to start kindergarten. The first day when he is sitting with the group the boy next to him says loudly “What are those things in your ears.” Jimmy has always been around his family and others who know about the hearing aids so he hasn’t been prepared for questions like these. He feels confused and ashamed. He says, “They’re my hearing aids.” The other boy makes a grab for the aid so he can see it better and they get into a tussle. The teacher calls them out to stop fighting. On the first day of kindergarten Jimmy learned that his hearing aids get him in trouble, and other kids look at him funny. The students don’t know what ‘those things’ are or why he needs them so they start to tease and avoid him. Even though he has worn hearing aids as long as he can remember, he starts to wonder what would happen if he ‘forgets’ them at home…

Setting the stage for rejection of hearing devices

We develop our identifies by defining ourselves as members of various groups. To develop a healthy identity where it is okay to be a person who uses hearing devices, a child must be exposed to, and interact with, other children who use hearing devices. In the current model of full inclusion, it is becoming less and less likely that a student with hearing devices will see another student who is hard of hearing. As the acceptance of peers becomes more important in grade 2 and increases throughout middle school, it becomes more likely for the child who uses hearing devices to want to be ‘normal’, meaning not use hearing aids and/or a DM system. It is not surprising that there are now reports of more children rejecting hearing devices, especially DM systems, at earlier ages than previously, when they had regular interactions with peers who used hearing devices.

What can be done to develop students who feel good about themselves
and ready to deal with peer acceptance issues?

Before he enters kindergarten if possible, prepare the child that he will be asked questions

Other kids probably haven’t seen a child using hearing aids and won’t know what they are

He will be asked questions about what the hearing devices are and why he uses them

Other children may want to handle the devices and he needs to be able to discourage this appropriately, so they are not broken

People do not understand what it means to have a hearing loss.

Work with the child to develop an understanding of what a hearing loss is, and what that means

He knows he is the kid in the family that wears hearing aids but is likely to not have a clear understanding of why.

Use materials like the CHILD checklist questions and the My World tool (soon to be an app!) to discuss how the hearing loss means he has a smaller ‘listening bubble’ and challenges listening in noise, at a distance, and when people talk fast or have accents.

The hearing aids help him – A LOT! Unless he understands what it means to have a hearing loss and how the hearing aids help him, he won’t be able to explain it to others when they ask or to advocate for himself when he knows he will have a hard time hearing and understanding.

Inservice the class peers

Whether the child wants to play a role in talking about hearing and listening with his classmates or not, an adult needs to set the stage for student acceptance (teacher, parent, DHH specialist)

Discuss the importance of hearing and being a good listener in the classroom. What happens if someone can’t hear as well as others? Some children are born with ears that do not work as well as other peoples and they use hearing aids. Etc.

It is especially hard to understand in noise and when someone is talking at a distance. This makes it seem like the person could be ignoring you, but that is not true.

Discuss how to be respectful when talking to others. Get their attention first, etc.

Demonstrate the use of the DM system. Allow the child to ‘shine’ as the teacher steps away and quietly asks a question that the rest of the class cannot hear but the child using the DM system can answer.

Answer questions – the classmates will be curious!

He WILL be teased. What should he do?

While some children will ask about the hearing devices because they are curious, others will tease the child. Discuss teasing:

Why do children tease?

Is he the only one who gets teased? Only kids with hearing aids get teased?

Children who connect with others who have similar hearing loss and device use will be more self-confident and resilient to peer pressure. Holding regular group meetings digitally (i.e., Skype, Zoom, etc.) among students to meet instructional goals for self-advocacy is an effective way to increase student success – socially, emotionally, and academically!